PROJECT SUMMARY/ABSTRACT There is a critical shortage of blood that affects many countries in Sub-Saharan Africa. Blood collection rates in these regions are ten-fold lower than rates in high-income countries. According to the Kenya National Blood Transfusion Service (KNBTS), the country's healthcare system requires nearly 500,000 units of blood per year. Last year, collections reached just 30% of this mark. Unfortunately, the blood transfusion processes span a continuum from blood donation to safe delivery that is complex, expensive, and prone to failure. The consequences are devastating; postpartum hemorrhage, malarial anemia, sickle cell disease, and all other forms of acute hemorrhage claim millions of lives each year. Thus, optimizing blood transfusion services in LMICs represents both a major health challenge and a social imperative. The overarching goal of this project is to identify, develop, and test effective strategies to enhance the availability and delivery of safe blood for transfusion in Kenya. A research consortium led by Strathmore University and the Center for Public Health and Development (CPHD) in Nairobi has partnered with the University of Pittsburgh with the objective of defining and characterizing the blood transfusion system in Kenya in order to provide evidence for the effective implementation of a diverse set of interventions aimed at enhancing and streamlining the safe delivery of blood in both urban and rural Kenya. Our research team has designed a multidimensional three-by- three-by-three approach that consists of three clinical pathways determining the urgency of blood transfusions; three distinct socioeconomic contexts within Kenya that best represent both urban and rural settings; and three basic components of effective blood transfusion systems (availability, processing, and safe delivery). Our specific aims are: 1. Evaluate ground-level deficits in the continuum of banked blood transfusion ? specifically availability, processing, and delivery ? across three distinct socioeconomic contexts in Kenya (Nakuru, Siaya/Kisumu, and Turkana counties), and within three specific clinical contexts (emergent, urgent, planned); 2. Evaluate ground-level and consensus solutions to optimize the continuum of banked blood transfusion; and 3. Identify disruptive technologies for the implementation of safe and reliable blood transfusion strategies, including innovative supply-chain solutions and crowd-sourcing through social media and mobile technologies. This work will elucidate barriers to safe blood access and quantify the impacts of unavailable blood in each clinical situation. During the UH3 phase of the project, we aim to implement innovative, contextually appropriate, stakeholder- backed interventions to address deficits across the blood continuum, ultimately optimizing blood donation, collection, testing, and timely availability so that blood is given to the right patient at the right time and location, ensuring the highest quality of blood transfusion services in low resource areas.